Nail Psoriasis in Pediatric Populations

ABSTRACT Pediatric nail psoriasis is an under‐recognized yet clinically important manifestation of psoriasis with both diagnostic and prognostic implications. Nail involvement in children is associated with greater overall disease severity, poorer treatment outcomes, and is a predictor for the development of psoriatic arthritis. Nail pitting is the most common feature in pediatric populations. This review gives a brief overview of the epidemiology and clinical features and focuses on the current evidence for the management of pediatric nail psoriasis. Available data on treatment efficacy remain limited in this population and are largely derived from case reports and small case series. Topical therapies are generally considered first‐line treatment, although efficacy may be limited by poor nail penetration. Intralesional triamcinolone has demonstrated good efficacy in pediatric populations when tolerated. Nail involvement is associated with increased likelihood of treatment escalation, including transition to systemic treatment and biologic therapies. Among biologic agents, interleukin (IL)‐12/23 and IL‐17A inhibitors such as ixekizumab and secukinumab, are the most well‐supported in the literature and have shown promising efficacy in pediatric patients across varying severity of nail disease. Further high‐quality studies are needed to guide evidence‐based management of pediatric nail psoriasis and optimize treatment outcomes.